Lithium toxicity - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:42Z

Strip excess bold

Danbot: Update: improved pharmacokinetics, EXTRIP HD indications with recommendation grades, SILENT syndrome, fluid targets, serial level monitoring, post-HD rebound, added references with PMIDs

2026-03-21T19:37:43Z

Update: improved pharmacokinetics, EXTRIP HD indications with recommendation grades, SILENT syndrome, fluid targets, serial level monitoring, post-HD rebound, added references with PMIDs

Show changes

Bobbycarey: /* Chronic */

2021-10-17T16:42:59Z

Chronic

← Revisión anterior		Revisión del 16:42 17 oct 2021
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	Occurs insidiously in patients on chronic lithium therapy. Toxicity is secondary to increased absorption or decreased elimination. CNS symptoms predominate.		Occurs insidiously in patients on chronic lithium therapy. Toxicity is secondary to increased absorption or decreased elimination. CNS symptoms predominate.

	Chronic lithium therapy is associated with nephrogenic diabetes insipidus, which → ~~hyponatremia~~, fluid loss → ↑ lithium levels (can precipitate toxicity)		Chronic lithium therapy is associated with nephrogenic diabetes insipidus, which → hypernatremia, fluid loss → ↑ lithium levels (can precipitate toxicity)

	*Neurotoxicity is major finding, and is generally more profound than that seen in acute toxicity		*Neurotoxicity is major finding, and is generally more profound than that seen in acute toxicity

Elcatracho: /* See Also */

2021-03-09T06:43:07Z

Hoxbox: /* Hemodialysis */

2020-10-27T18:02:24Z

Hemodialysis

← Revisión anterior		Revisión del 18:02 27 oct 2020
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	*Baseline renal failure		*Baseline renal failure
	*Contraindication to aggressive fluid resuscitation (CHF, etc)		*Contraindication to aggressive fluid resuscitation (CHF, etc)
			*Make final decision after consulting toxicologist and/or nephrologist since it's a complex decision <ref>Internet Book of Critical Care (IBCC) Lithium intoxication https://emcrit.org/ibcc/lithium/#dialysis</ref>

	==Disposition==		==Disposition==

ClaireLewis: /* Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49. */

2019-09-19T02:32:09Z

Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49.

← Revisión anterior		Revisión del 02:32 19 sep 2019
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	===Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)<ref>Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49.</ref>===		===Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)<ref>Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49.</ref>===
	Persistent sequelae of lithium toxicity. Defined as neurologic dysfunction persisting ~~more than~~ 2 months after cessation of lithium therapy. Exact mechanism unknown (possibly related to CNS demyelination).		*Persistent sequelae of lithium toxicity
			*Defined as neurologic dysfunction persisting > 2 months after cessation of lithium therapy
	Symptoms		*Exact mechanism unknown (possibly related to CNS demyelination).
	*Cerebellar dysfunction		*Symptoms
	*Peripheral neuropathy		**Cerebellar dysfunction ([[dysarthria]], [[ataxia]], [[tremor]], gait instability)
	*Extrapyramidal symptoms		**Peripheral neuropathy
			**[[Extrapyramidal symptoms]]
	*Brainstem dysfunction		*Brainstem dysfunction
	*Dementia		*[[Dementia]]

	==Differential Diagnosis==		==Differential Diagnosis==

Ktanner777: /* Evaluation */

2019-09-18T15:47:09Z

Evaluation

← Revisión anterior		Revisión del 15:47 18 sep 2019
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	*Lithium level		*Lithium level
	**Therapeutic level = 0.6-1.2 meq/L		**Therapeutic level = 0.6-1.2 meq/L
	**''level may be falsely elevated if placed in a green top tube due to the heparin lithium interaction''		**''Serum level may be falsely elevated if placed in a green top tube due to the heparin lithium interaction''
			**''Serum levels do not predict CNS levels and only roughly correlate with clinical symptoms''
	*Metabolic Panel		*Metabolic Panel
	*TSH		*TSH

ClaireLewis at 01:16, 2 September 2019

2019-09-02T01:16:24Z

← Revisión anterior		Revisión del 01:16 2 sep 2019
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	Serum concentrations can fall rapidly as lithium redistributes to tissues, and serum level does not correlate with degree of toxicity. GI symptoms predominate.		Serum concentrations can fall rapidly as lithium redistributes to tissues, and serum level does not correlate with degree of toxicity. GI symptoms predominate.

	*GI - nausea, vomiting, diarrhea, abdominal pain		*GI - [[nausea/vomiting]], [[diarrhea]], [[abdominal pain]]
	**Earliest and most common symptoms		**Earliest and most common symptoms
	*Cardiac effects - bradycardia, QT prolongation, T-wave flattening or inversion<ref>Canan F, Kaya A, Bulur S, Albayrak ES, Ordu S, Ataoglu A. Lithium intoxication related multiple temporary ecg changes: A case report. Cases Journal. 2008;1:156. doi:10.1186/1757-1626-1-156.</ref>		*Cardiac effects - [[bradycardia]], [[QT prolongation]], T-wave flattening or inversion<ref>Canan F, Kaya A, Bulur S, Albayrak ES, Ordu S, Ataoglu A. Lithium intoxication related multiple temporary ecg changes: A case report. Cases Journal. 2008;1:156. doi:10.1186/1757-1626-1-156.</ref>
	**Can also cause Brugada-like ECG pattern		**Can also cause [[Brugada]]-like ECG pattern
	*CNS Depression - late finding (takes time for lithium to distribute to CNS), indicates progression of toxicity		*CNS Depression - late finding (takes time for lithium to distribute to CNS), indicates progression of toxicity

Línea 43:		Línea 43:

	*Neurotoxicity is major finding, and is generally more profound than that seen in acute toxicity		*Neurotoxicity is major finding, and is generally more profound than that seen in acute toxicity
	**Mild symptoms include tremor, drowsiness		**Mild symptoms include [[tremor]], drowsiness
	**Progressive symptoms include hyperreflexia, confusion, ataxia, seizures, extrapyramidal ~~signs~~, coma		**Progressive symptoms include hyperreflexia, [[confusion]], [[ataxia]], [[seizures]], [[extrapyramidal symptoms]], [[coma]]
	*Hypothyroidism (lithium inhibits thyroid hormone release)		*[[Hypothyroidism]] (lithium inhibits thyroid hormone release)

	===Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)<ref>Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49.</ref>===		===Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT)<ref>Adityanjee, Munshi KR, Thampy A. The syndrome of irreversible lithium-effectuated neurotoxicity. Clin Neuropharmacol. 2005 Jan-Feb;28(1):38-49.</ref>===
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	*Average patient has Na/volume deficit; giving fluid helps reestablish normal renal Lithium excretion		*Average patient has Na/volume deficit; giving fluid helps reestablish normal renal Lithium excretion
	*Give 2L NS bolus, then start 200mL/hr or 2x maintenance rate		*Give 2L NS bolus, then start 200mL/hr or 2x maintenance rate
	===~~Dialysis~~===		===[[Hemodialysis]]===
	''Most effective method of removal. Must follow serial lithium levels - levels will likely rise after HD due to redistribution from tissues; additional HD may be required.''		''Most effective method of removal. Must follow serial lithium levels - levels will likely rise after HD due to redistribution from tissues; additional HD may be required.''
	'''Indications:'''		'''Indications:'''

Rossdonaldson1: /* Background */

2018-08-12T21:39:44Z

Background

@@ Línea 6: / Línea 6: @@
 **[[NSAIDs]], [[diuretics]], [[ACE-inhibitors]] → ↑ Lithium serum concentration by ↓ lithium excretion
 *Lithium toxicity rarely fatal (only 11 deaths out of 6815 reported toxic exposures in 2012)<ref> Mowry JB, Spyker DA, Cantilena LR Jr., Bailey JE, Ford M: 2012 annual report of the American association of poison control centers’ national poison data system (NPDS): 30th annual report. Clin Toxicol (Phila) 51: 949–1229, 2013</ref>
 ==Clinical Features==

Rossdonaldson1: /* Differential Diagnosis */

2018-08-12T21:39:19Z

Differential Diagnosis

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	==Differential Diagnosis==		==Differential Diagnosis==
	~~===Common Precipitants===~~		{{Heavy metals list}}
	*Overdose
	*Renal failure
	*Volume depletion
	**Diuretic use, [[vomiting]], [[diarrhea]], diaphoresis, decreased oral intake
	*[[Hyperthermia]]
	*Infection
	*[[CHF]]
	*Surgery
	*Cirrhosis

	==Evaluation==		==Evaluation==

← Revisión anterior		Revisión del 06:43 9 mar 2021
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	*[[Toxicology (Main)]]		*[[Toxicology (Main)]]
	*[[Lithium]]		*[[Lithium]]
			*[[Heavy metals]]

	==References==		==References==